title: Sustaining quality improvement and patient safety training in graduate medical education: lessons from social theory.
abstract: OBJECTIVE
  Despite an official mandate to incorporate formal quality improvement (QI) and patient safety (PS) training into graduate medical education, many QI/PS curricular efforts face implementation challenges and are not sustained. Educators are increasingly turning to sociocultural theories to address issues such as curricular uptake in medical education. The authors conducted a case study using Bourdieu's concepts of "field" and "habitus" to identify theoretically derived strategies that can promote sustained implementation of QI/PS curricula.
  
  
  METHODS
  From October 2010 through May 2011, the authors conducted semistructured interviews with principal authors of studies included in a systematic review of QI/PS curricula and with key informants (identified by study participants) who did not publish on their QI/PS curricular efforts. The authors purposively sampled to theoretical saturation and analyzed data concurrently with iterative data gathering within Bourdieu's theoretical framework.
  
  
  RESULTS
  The study included 16 participants representing six specialties in the United States and Canada. Data analysis revealed that academic physicians belong to, and compete for legitimate forms of capital within, two separate but related fields associated with QI/PScurricular implementation: the "academic field" and the "health care delivery field." Respondents used specific strategies toexploit and/or redefine the prevailingforms of legitimate capital in each field to encourage changes inacademic physicians' habitus that would legitimizeQI/PS.
  
  
  CONCLUSIONS
  Situating study findings in a sociocultural theory enables articulation of concrete strategies that can legitimize QI/PS in the academic and health care delivery fields. These strategies can promote sustained QI/PS curricula in graduate medical education.
authors.affiliation: Continuing Education and Faculty Development in Quality and Safety, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. BrianM.Wong@sunnybrook.ca
authors.forename: Brian M
authors.initials: BM
authors.lastname: Wong
authors.forename: Ayelet
authors.initials: A
authors.lastname: Kuper
authors.forename: Elisa
authors.initials: E
authors.lastname: Hollenberg
authors.forename: Edward E
authors.initials: EE
authors.lastname: Etchells
authors.forename: Wendy
authors.initials: W
authors.lastname: Levinson
authors.forename: Kaveh G
authors.initials: KG
authors.lastname: Shojania
mesh_terms: D002170:Canada; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D017145:Models, Educational; D061214:Patient Safety / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States